Reduced Intravenous Fluid Use and Operational Effects Among Emergency Department Patients During a National Shortage

In September 2024, Hurricane Helene disrupted U.S. intravenous (IV) fluid production, prompting rapid conservation. Our objective was to evaluate the association between IV fluid conservation efforts and changes in administration rates, ED length of stay (LOS), and 72-hour returns.

Retrospective analysis of discharged ED encounters from nine hospitals in a health system, comparing pre-shortage (October 1, 2023- January 31, 2024) and shortage periods (October 1, 2024- January 20, 2025). Primary outcomes were the proportion of discharged patients receiving IV fluids and ED LOS. Secondary outcomes were 72-hour return ED visits and IV fluid usage among high-risk conditions (Septic Shock, Diabetic Ketoacidosis [DKA], and sickle cell vaso-occlusive crises). We estimated odds ratios for IV fluid receipt by discharge diagnosis and linear regression coefficients for diagnosis-specific LOS.

Among 184,902 discharged encounters (98,460 pre, 86,442 shortage), IV fluid administration decreased from 19.0% to 6.4% (66.3% relative reduction). Odds of IV fluid declined across all top 20 diagnostic categories including diverticulitis (OR 0.11, 95% CI 0.07,0.17), headache (0.12, [0.11,0.14]), and abdominal pain (0.14, [0.13, 0.36]) . The shortage period was associated with increased LOS for many high-volume conditions including diverticulitis (β 0.51 hours, 95% CI 0.23, 0.79), Covid-19 (0.46, [0.28, 0.64]), and urinary tract infection (0.43 hours, [0.29, 0.57]) while only respiratory symptoms had decreased LOS (−0.25 hours, [−0.33, −0.16]). Significant increases in 72-hour returns occurred for kidney/ureter diseases, diabetes complications, alcohol-related disorders, and diverticulitis. IV fluid proportions were similar for septic shock and DKA but declined for sickle cell vaso-occlusive crisis.

The shortage reduced IV fluid administration among discharged ED patients and was associated with increased ED LOS and 72-hour returns for specific diagnoses. While targeted conservation appears feasible for some conditions, reductions in high-risk categories like sickle cell vaso-occlusive crises highlight the need for condition-specific allocation to prevent adverse outcomes during supply disruptions.